The DSM-III-R incorporates both distress (symptoms) and disability (impairment) in the definition of a psychiatric disorder. In psychiatric research there is a wide array of instruments used to measure symptom severity, but a limited selection for the assessment of impairment. The psychometric properties of one such instrument, The Sheehan Disability Scale (Sheehan 1983), are evaluated in this paper. The data analyzed come from two studies of patients with panic disorder, the Cross National Collaborative Panic Study--Phase I and the Panic Depression Study. In this report both the alpha coefficients and factor analyses indicate that the reliability of the scale is acceptable. The factor structure of the items and the sensitivity to change of their composite demonstrate satisfactory construct validity. The criterion-related validity is substantiated by the significant relationship between symptomatology and impairment. These analyses were limited to patients with panic disorder. Further work is needed to evaluate the instrument in assessing patients with other disorders.
A lifetime burden of panic-agoraphobic spectrum symptoms predicted a poorer response to interpersonal psychotherapy and an 8-week delay in sequential treatment response among women with recurrent depression. These results lend clinical validity to the spectrum construct and highlight the need for alternate psychotherapeutic and pharmacologic strategies to treat depressed patients with panic spectrum features.
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